Tuesday, 27 December 2011

Cognitive testing for all

Background: Cognitive impairment in MS impacts negatively on many MS'ers at all disease stages and in all subtypes. Full clinical cognitive assessment is expensive, requiring expert staff and special equipment. Test versions and normative data are not available for all languages and cultures.

Objective: To recommend a brief cognitive assessment for MS that is optimized for small centers, with one or few staff members, who may not have neuropsychological training and constructed to maximize international use.

Methods: An expert committee of twelve members representing the main cultural groups that have so far contributed considerable data about MS cognitive dysfunction was convened. Following exhaustive literature review, peer-reviewed articles were selected to cover a broad spectrum of cultures and scales that targeted cognitive domains vulnerable to MS. Each was rated by two committee members and candidates scales were rated on psychometric qualities (reliability, validity, and sensitivity), international application, ease of administration, feasibility in the specified context, and acceptability to patients.

Results: The committee recommended the Symbol Digit Modalities Test, if only 5 minutes was available, with the addition of the California Verbal Learning Test - Second Edition and the Brief Visuospatial Memory Test - Revised learning trials if a further 10 minutes could be allocated for testing.

Conclusions: A brief cognitive assessment for MS has been recommended. A validation protocol has been prepared for language groups and validation studies have commenced.

"This initiative is an attempt to get cognitive testing adopted into routine clinical practice. How do you know if you are cognitively impaired if you are not tested for it?"

3 comments:

As someone with MS, I have to disagree. I'm a graduate and professional. I don't think I've experienced any cognitive decline - those I report to are best placed to let me know if my work isn't up to scratch. Cognitive decline from MS would be another nail in the coffin - I'd rather stick my head in the sand and not be tested. You're an academic / professional like me - would you really want to know the level of decline in your cognitive abilities if you had MS? But the real issue is there's no treatment! Why do I need to find out / worry when there's nothing that can be done (by this I mean replace the lost brain cells - not some hocus pocus like CBT).

Re: "As someone with MS, I have to disagree. I'm a graduate and professional. I don't think I've experienced any cognitive decline - those I report to are best placed to let me know if my work isn't up to scratch....."

I don't test cognition in routine clinical MS practice unless the information is required for a specific reason; for example an occupational medicine or disability benefit enquiry. This would obviously change if we had a treatment for poor cognition. That observation that you don't have any apparent deficits is the norm; the problem is that this does not mean you don't have any deficits; fortunately the brain is very good at compensating. The latter is also an issue in other cognitive disorders, for example Alzheimer's disease.

Thanks for the message. hope you have a great year as well; disease activity and progression free.

What are your thoughts on the apparent disconnect between the perception of people with MS about their cognitive abilities and the results of objective testing? It seems to go both ways: over- and underestimating of cognitive problems.

For example, I occasionally catch myself using a bizarrely different word in writing or speech than I intend (or my husband catches me). I suspect this happens more often than I notice and I'm left wondering what else I don't notice.

Thinking that one's mental abilities are worse than they objectively are seems to be attributed to all sorts of things, including depression, fatigue, anxiety, and conscientiousness. On the other hand, most of the people I know who were told their neuropsych evaluations were good, but felt like they were suffering from cognitive decline attributed it to the fact that the tests measured against some average normal when they were measuring themselves against what they personally had previously been able to do. Maybe that's an argument for getting a baseline.

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